|
Zoster (shingles) vaccine, live, subcutaneous injection POC
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
757310
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna of AZ Commercial |
$399.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$71.04
|
| Rate for Payer: Banner UC Health Medicare |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$71.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$71.04
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna of AZ Commercial |
$310.80
|
| Rate for Payer: Devoted Health Medicare |
$79.92
|
| Rate for Payer: Humana of AZ Medicare |
$71.04
|
| Rate for Payer: Southwest Service Administrators UFCW |
$301.92
|
| Rate for Payer: TriWest Medicare |
$71.04
|
| Rate for Payer: United Healthcare Commercial |
$253.97
|
| Rate for Payer: United Healthcare Medicare |
$71.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$70.33
|
|
|
Zoster (shingles) vaccine, live, subcutaneous injection POC
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
757310
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna of AZ Commercial |
$399.60
|
| Rate for Payer: Cash Price |
$355.20
|
|
|
zoster vaccine, inactivated adjuvanted REC[CQCH]
|
Facility
|
OP
|
$133.99
|
|
|
Service Code
|
NDC 58160082311
|
| Hospital Charge Code |
136004511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna of AZ Commercial |
$120.59
|
| Rate for Payer: Arizona Complete Health Allwell |
$21.44
|
| Rate for Payer: Banner UC Health Medicare |
$21.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$91.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$21.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$21.44
|
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Cigna of AZ Commercial |
$87.09
|
| Rate for Payer: Devoted Health Medicare |
$24.12
|
| Rate for Payer: Humana of AZ Medicare |
$21.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$91.11
|
| Rate for Payer: TriWest Medicare |
$21.44
|
| Rate for Payer: United Healthcare Commercial |
$76.64
|
| Rate for Payer: United Healthcare Medicare |
$21.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.22
|
|
|
zoster vaccine, inactivated adjuvanted REC[CQCH]
|
Facility
|
IP
|
$133.99
|
|
|
Service Code
|
NDC 58160082311
|
| Hospital Charge Code |
136004511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.59 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna of AZ Commercial |
$120.59
|
| Rate for Payer: Cash Price |
$107.19
|
|
